self payer concerned about complications

[iggychic 1,405]

I was self pay in the US and I had severe complications. My total bills were near half a million for the recovery care due to the complications. My insurance does not cover the surgery for low BMI (nor will it ever) so for me this was "elective".

But my insurance covers any life threatening medical needs. Fortunately? Ok only for insurance purposes, I did have life threatening medical needs. I went through the ER for all extra visits and was admitted via an ER each time, this makes a difference in our coverage verses having the PCP see me and then send me to the hospital. You're going to want to find out what the specific rules are. There are funny twists, for instance ambulance coverage was 100% for me from the ER and yet if I'd had called them to the house it would have been a minimum $500 per trip. One trip was five hours so that's A LOT of money! Nutrition visits are covered but blood work has to be ordered by my PCP for coverage verses the surgeon. Silly stuff, and in my case I just pay verses using the second (PCP) doctor because we are self insured (so the money comes out of my pocket anyhoo over time) but you need to know the rules inside and out. Like someone said, read the policy and KNOW IT!

I didn't read my policy. I went in paying cash and was clear I wasn't going to have any complications as I was low BMI with no comorbidities and no issues with anesthesia....ha I was wrong!!! I wouldn't have been ruined (it would have hurt, but wouldn't have forced us to sell a kid or anything) by having to pay cash if the complications weren't covered, but that's not typically the case so DON'T go in blind for gads sake!

As to your parents responsibility. Is your insurance through your parents? They could actually have some responsibility if they insure you, much like a spouse does when their insurance covers you. So you are taking the responsible road by checking that out. Ordinarily they wouldn't be if you are over 21...but that isn't always the case for someone on another person's policy. You'll want to be sure to have that conversation with them.

Were you my child I'd be appreciative of how much you're researching this.

[BKLYNgal87 503]

Hi iggychic,

I have my own insurance policy independent of my parents, so any debt incurred would be mine alone. They are willing to loan me money in the event that the surgery isn't covered by my carrier so that I can self pay. But there still may be hope - I am having another sleep study next week after my fiance informed me that I wake up at night gasping for air (which I never remember) so my sleep apnea may have gotten worse. Not that obstructive sleep apnea is something to be happy about >_< But it's considered a serious enough comorbidity to approve surgery for those with a BMI of 35+.

Also, sorry to hear you had such serious complications. Hope you have recovered fully from them. It's definitely something that should weigh heavily on anyone's mind considering WLS and I am no exception. Though I guess at the end of the day everyone tries to figure out what is right for them. I am fortunate in that I see a fairly accurate picture of my future (if I don't take control of my life) in my relatives, especially my dad. I love him dearly but it's not a pretty sight. And I know he wants a different life for me.

So I did read the policy and limitations booklets through my employer and found for the most part that complications of elective surgery are well covered with some small random exceptions. But they won't pay for things like plastic surgery to remove excess skin after an elective WLS. Hopefully being still fairly young I won't need it

Thank you all for your suggestions!

[iggychic 1,405]

Honey can I adopt you? LOL I want a child that grows up as smart as you

My complications were rare and you shouldn't expect them, but the fact that you're looking to answer the "what if's" impresses me. I think given you are your own insured, you'll be ok and your parents won't be on the hook legally (morally...if my child died during a surgery would I cover it?????? probably) but again that's a conversation for your family to have. I just like reading your thought process. It's responsible and tells me you'll do well with this.

You are a 40 plus bmi with one comorbidity...you should be covered hun. I was 35ish with none and while I'd like to make it not legal for people like me to have the surgery, (and no one in my company will because we set the policy) I highly feel that the standards (40 + or 35+2 ) are fair. I hope to hear you find you're covered.

If you do end up going MX please think through the process and co insurance because (for instance) my insurance specifically would not allow coverage for anyone who had a non - US elective surgery with complications. We pride ourselves on very high level coverage...so we are very lenient, but that's not something I'd add to our policy if I had the option. You want to differentiate carefully.

Anyhoo....are you available for adoption? LOL Ok maybe not, but I wish you the best darling. You sound like your parents have done a lovely job raising a smart young lady I mean that as a compliment

[blondie1007 51]

I am glad my story could be an inspiration to you. Just be sure to do your homework. I researched the surgery and my doc for over a year before making a move. Good luck to you.

[nurseghana 167]

I too denied me 6 x I am scheduled to have a vertical sleeve in Mexico on February 27 went Dr Fernando Garcia